No Care Under Obamacare

February 3, 2014

At this point we’ve all heard about the problems plaguing Obamacare, from the poor security on the Healthcare.gov website, to the glitches on the web that prevented many Americans from purchasing health care on the exchanges in the first place. Or, even if visitors did “purchase” their health care coverage with a healthy government subsidy, they still had to check with their insurer to confirm that the application made it to the right place with the right background information.

But new information shows that Obamacare coverage is, for many, no care at all despite the high prices. The idea that you can keep your doctor has been exposed as a bold-face liereaching up to the President himself. But the fact that you not only cannot keep your doctor, but even when insured, may not be able to find a doctor in your own county or city, is what’s surprising some Americans.

“But, as it stands, Obamacare is largely a health insurance replacement system rather than an expansion,” writes Michael Gersonfor The Washington Post. “And the replacement is often less generous, more expensive and more restricted in options than promised.” The Wall Street Journalhas reported that 65% to 90% of the 2.2 million who had purchased health insurance on the exchanges by the end of 2013 already had health insurance.

These new enrollees may be surprised by what they’re about to get themselves into. Politicoreported this month that Republican Senator Tom Coburn (OK), who is struggling with cancer, can no longer see his oncologist using his Obamacare plan. He’s opted to pay out of pocket to see this doctor. “We hope the White House will work with us to make sure Americans who can’t afford to pay out of pocket don’t lose access to life-saving care,” said Coburn spokesman John Hart.

Not everyone has money lying around to pay for medical care out of pocket, especially if they are paying skyrocketing premiums. According to The Washington Free Beacon, two Tennessee residents signed up for the micro network BlueCross Network E under Obamacare and can’t see the doctor. “‘We have health insurance at this point that is worthless,’ Shawnna Simpson said of the plan that she pays $600 a month for,” reported the Beacon. She can’t find a family doctor in her county that accepts her plan. And David Pearce was rejected by his doctor’s office for using this health plan as well.

“BlueCross Network E is a micro network—a very small network with limited doctors and hospitals,” reports the Beacon (emphasis added). “Neither Vanderbilt nor TriStar are in the network.”

Lest you think this is an outlier, consider that “a Dec. 13 McKinsey study of 20 U.S. metropolitan areas found that two-thirds of ACA plans analyzed had ‘narrow’ or ‘ultra narrow’ networks, with at least 30 percent of top 20 hospitals excluded for coverage,” according to Time magazine. In other words, two-thirds of these Obamacare plans had restricted coverage networks.

Time titled their piece “Obamacare: Keeping Your Doctor No Easy Feat,” an implicit recognition that the President’s promise that if you like your doctor you can keep him or her was a lie.

But then Time goes off the deep end in quoting sources who argue, unfathomably, that what is happening in Obamacare is “market competition.” That is how Karen Pollitz, “a senior fellow at the Kaiser Family Foundation who studies the insurance market,” characterized it. “Whether you like it or not, this is what we signed up for,” she said.

Pollitz is identified as “work[ing] for the Department of Health and Human Services helping to implement the ACA before taking a post at Kaiser.” Clearly, she is no unbiased source, yet she is quoted extensively.

The other source, Dr. Jeff Rideout, is the California “exchange’s senior medical adviser.” He says that “Better value occurs when there’s better alignment between a plan and a relatively tight network.”

“In other words, when insurers and providers are more dependent on each other, there’s more motivation to deliver efficient care,” reports Time’s Kate Pickert.

Let’s unpack the word “efficient” for a second.

Paul Hsieh, writing for Forbes, notes that, before Obamacare, the incentives for doctors were to sometimes over-bill by prescribing unnecessary care and procedures. The incentive under Obamacare, however, is to provide less care. “Under ObamaCare, doctors will face increasing incentives for undertreatment rather than overtreatment,” writes Hsieh (emphasis in original). For example, it includes pilot programs that replace the fee-for-service model with bundled payments. “If the hospital and doctors treat the patient for less than the bundle, they keep the excess,” writes Hsieh. “But if their costs exceed the bundled payment, they must absorb the loss.” In other words, profit comes from short-changing the patient.

As for “narrow networks,” they “will create a powerful incentive for physicians to adhere to any treatment guidelines mandated by the government or by government-approved insurance plans,” and effectively drive a wedge between the patient and the physician because “many doctors will lose long-standing relationships with patients they’ve seen for years,” he writes.

This, Time magazine brazenly allows to be called market competition. It actually is a realignment of the marketplace that favors the poor against the wealthy and redistributes wealth in the name of liberalism. “In part, Obamacare is fashioned as a vehicle to redistribute income through healthcare benefits,” writes Scott Gottlieb for Forbes. And a new study by the Brookings Institution finds it does just that—it “increase[s] the incomes of Americans who fall in the bottom one-fifth of the income levels, while slightly decreasing…the incomes of senior citizens,” according to USA Today. And it reduces the income of the wealthy using Medicare taxes.

Despite all that, Obamacare still seems to be giving poor families the short straw. “Children who qualify for Medicaid, the safety-net program for the poor and disabled, can’t be included on subsidized family plans purchased through the federal marketplace, a fact that is taking many parents by surprise and leaving some kids stuck without coverage,” reported CBS. “And in New Hampshire, some parents who’ve enrolled in private plans for themselves alone are finding out later that their children aren’t eligible for Medicaid after all, leaving their kids with no options.” For many, those seem to be the main features of Obamacare: high costs, no options, and no coverage.